Intent to Retire

Intent to Retire

Employee's Legal Name

Job Title

Retirement Date

Must always be the first day of the month. If the exact date is unknown, please enter a tentative date.

Date of Hire

Date of Birth

Age

Mailing Address / Street Address

City

State

Zip Code

Phone Number

Please provide personal phone number (not UWG office number)

Email Address

Please use personal email -- Not UWG Email address

Do you have any prior State of Georgia service?

To include other USG institutions

Select or enter value

Employee Type

Select or enter value

Exempt/Non-Exempt

Select or enter value

Retirement Provider

Select or enter value

Supplemental Retirement Plan

This would be your 403b or 457b

Select or enter value

Supplemental Retirement Vendor

Select or enter value

Notes

Send me a copy of my responses

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